Provider Demographics
NPI:1851896146
Name:SSM MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:SSM MEDICAL GROUP, INC.
Other - Org Name:SSM HEALTH EXPRESS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:149-946-2193
Mailing Address - Street 1:PO BOX 955534
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-5534
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1101 HIGHWAY K STE A
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-8431
Practice Address - Country:US
Practice Address - Phone:844-766-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SSM MEDICAL GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-28
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center